Transcription
Then apart from collagen, we have astaxanthin and beta-carotene. They act as an internal sunscreen, producing more melanin. It may make sense to supplement lutein and beta-carotene, but that converts into vitamin A, which accumulates and can become toxic, whereas astaxanthin does not. Orally, hyaluronic acid has proven beneficial for both hydration and the aspect of wrinkles in several meta-analyses. So, in the case of the skin, I would say it's one of the easiest organs to regenerate. We have to cause some harm to activate its regenerative capacity. So, what do we use? Usually, we use... When I started almost 10 years ago, my wrinkles in the eyelid area were deeper. I haven't evolved any deep expression wrinkles, although I tend to use my forehead a lot when I read, and I haven't used Botox on myself.
Alexis, welcome to the podcast. Thank you for inviting me. Hi, everyone. Today I'm with Alexis Ortega, who is a medical doctor from Barcelona, Spain. He is the founder and medical director of Adastro Clinic, specialized in regenerative medicine, longevity, and skin. He has worked as a medical advisor for longevity supplement startups, as well as the pharma industry and the aesthetic medical industry, collaborating in product development. He has a board certification in regenerative medicine and master's degrees in hair and skin aesthetic medicine and stem cell therapy, and a postgraduate diploma in longevity and anti-aging medicine.
Whoa. Uh, we also met in India a few months ago, and that was very inspiring. We were at the longevity retreat that we are organizing, and we did all sorts of longevity tests and treatments and had very good chats. And you also did a podcast with Sim, which is super inspiring. I would recommend everyone to also listen to that one, and we can kind of expand and go in-depth in some of the areas from the discussion as well that you didn't cover necessarily in that depth.
So, let's start with just how did you get... like you have such a massive background in longevity and regenerative medicine, and you did like what, 150 master's degrees and postgraduates? So, um, I like to keep myself busy. Yeah, I can see that. So, how did you get into the field of longevity? Like, uh, there is probably hundreds of things that you can do as a doctor and the specializations. So, what was it in longevity and aesthetic medicine that kind of called you?
Yes, definitely. Well, I didn't start, uh, my professional career in longevity medicine. I think it was part of a personal evolution, um, as I started with the aesthetic medical field. So, I started treating, just doing Botox, uh, fillers, and, and treating the external signs of aging, so to speak. Um, I started realizing the importance of aging itself and also the will of, uh, wanting to do something more meaningful. It's not that that aesthetics cannot help people a lot with self-confidence and also by improving appearance. Uh, they have a different attitude towards life, and they feel more active, more youthful. That's something I've seen for a long time. Uh, it's that I wanted to complement or change the focus of what I was doing. I wanted to focus on the concept of regenerative medicine and apply it to aesthetics and to pathologies. So, to help, uh, people in any way possible, in any way that science can provide, um, in reducing their chances of developing, um, any type of degenerative disease or chronic disease, or if they had already developed it, in improving, uh, their quality of life, making, helping them live healthier, free of any burden for longer, and also giving them a more youthful appearance, but by treating the root cause of, uh, of their skin, hair, or appearance aging. So, that was the, the main focus.
So, you asked when I started doing that. That's, uh, as it's been a gradual process. I would set the date in 2021, probably after the pandemic. Uh, that's when, when the big shift took place. Uh, I decided to, to leave the clinic where I had worked for the past six years, and I decided to open a new chapter, uh, and develop my own thing. And that was, uh, that was the, that was the turning point. So, I opened, uh, first a clinic in Palma de Mallorca, and then last year, I opened one in Barcelona, and there I am developing this concept of regenerative medicine applied to longevity and aesthetics. And my main inspiration, as I told Sim during our podcast, was, uh, Aubrey de Grey and his theory of, uh, damage repair and strategies for negligible senescence, which focuses on identifying the different types of damage that appear with aging and apply a divide and conquer approach to tackle them with the goal of extending health and ultimately extending life.
That's great. Uh, you do have quite a unique approach and quite a clear approach to longevity that I think makes tons of sense. Can you walk us through briefly the three-step process that you developed? Mhm. Definitely. So, the main structure of my protocol has three phases. And phase one would be first and foremost, diagnosis assessment. So, I do lots of tests that depends on, on the profile, on the patient profile. But what I usually do is a very extensive, comprehensive blood test, a urine test, and then more specialized tests such as telomeres, epigenetic clocks, NAD levels, intracellular NAD levels, not blood NAD levels, which are the ones that matter, intracellular NAD levels. Also, assessment of immune function, not just by routine blood tests, which only quantify the number of, uh, immune cells and subtypes that you have, but the activity of those immune cells, which is what really matters. What else? Um, toxic heavy metals. Um, we analyze them in the hair because it's the, the most reliable source of, uh, metals and other toxins that accumulate in the body, as opposed to blood. And, uh, in the most extensive protocol, I also sequence the entire genome of the patient to get to know all of his or her, uh, genetic risks. So, that would be step one, assessment, gather all the information, and then with that, we design a personalized, precise protocol for phase two, which would be detox, and phase three, which would be regeneration.
Um, I, I kind of want to delve deeper into the detox today because I think that's extremely important and nobody really talks about it. But before that, one question that came into my mind is that is there, have you noticed that there is like, one specific test that would be maybe more indicative of the, of the regenerative capacity of that person than others? You mentioned several tests, NAD, telomere, what not. Do you think there is something that's above all that it's like the most important or among them?
H, the most important one in clinical medicine would be blood tests, and nothing surpasses that yet because it's a functional test. It gives you, it translates the way your organs are functioning today, and with that, you can predict mortality and health. So, the other tests are all compliments, but that doesn't mean that just by analyzing what's in your blood now, we have enough information, enough information to, to achieve a good prevention in the future. There's lots of things that we are ignoring. So, that's why I combine it with, with those tests that provide some meaningful data that complements what we know about your blood tests. And I've had cases of patients with perfect blood tests, no alterations, and for, for instance, extremely low NAD levels. And that, in their case, uh, in, in one specific case of, that was diagnosed of chronic fatigue, that was the root cause of his fatigue. So, it wasn't a nervous, um, um, so chronic fatigue, I'm sure you're familiar with it. It's, uh, sort of, it's related with, with the central nervous system, and it implies alterations in neurotransmitters. So, in that case, it was a misdiagnosis, because just by improving NAD levels, which were abnormally low, even for his age, um, we achieved remission of all his symptoms, and he could get back to having a normal life.
Chronic fatigue is sometimes used as a, a diagnosis when, when no other explanation can be given. Yeah. By the, by the mainstream, uh, tests. H, that is true, and it's, it's quite difficult to treat, or I, I feel like in a lot of the cases, the patients are left without any tools. They just say that, that this is the, this is the case, now you have a chronic fatigue, and there is nothing that has been established that could help. Sometimes it's, the consequence of a chronic infection, which is, to me, the most difficult cases to treat, because there's already been a strong insult in the nervous system, for example, Epstein-Barr virus, or cytomegalovirus, herpes virus. And I've had patients that have had the three of them, even followed by coronavirus. So, those are the tricky ones. Uh, I think in those cases, we must focus on, uh, improving all the antioxidant indices, uh, reducing chronic inflammation, and stimulating, uh, tissue regeneration. Yeah. But even with that, it's difficult. Yeah, for sure.
Okay. Then the second step of your approach is the detox, and this is quite interesting. So, what are the most important things to detox from the body? Why, why is detox in the first place for them?
F, first of all, let's explain to our audience that, uh, our bodies are constantly exposed to all sorts of toxins, or junk, either from the, from the air we breathe, from pollutants, or from the water we drink, or even from the clothes we wear, from the microplastics. So, we have three main windows of entrance for the toxins. One's the skin, the other one's the air or lungs, and the other one's the gut, the intestine. So, um, this has become a problem because we live far longer than what, uh, evolution, uh, expects from us, and we are surrounded by modernity. We don't live in a natural environment. So, we've developed lots of technologies that have the downside of polluting the environment and polluting our bodies. And therefore, what we can do now is try to potentiate the body's ability to remove the innate ability, the evolutionary ways the body has to remove the types of junk it is familiar with. So, the ones it can remove, and aid it in those that it is not familiar with and it cannot remove, or it has more difficulty removing, such as microplastics, because we, we haven't evolved surrounded by microplastics. So, we haven't evolved, uh, very efficient mechanisms for removing them from the body. Right.
Okay. So, what would be some of the tests to do to know if we are, if we do have this, uh, old junk, or we do have these external things in our bodies that we don't want to keep there?
Definitely. In, in this case, as I told before, I rely on hair mineral analysis. It's basically having a few hairs removed, a few hairs cut and analyzed, and the content of the hair will tell you what has been accumulating in your body for the past two to three years. So, it's not like you have been exposed to mercury because you, you ate fish two days ago, which could be seen in your blood test. It's, uh, more of the long-term exposure and what still is inside your body. So, what your body has not been able to eliminate by itself. And then that test will basically provide, uh, information about all minerals. So, if you have any deficiency on any mineral, we will know as well, such as iron deficiency. You know, iron markers from the blood are not really reliable. Um, so, it's, uh, difficult to know the exact deposits of the blood, uh, of the body, of iron, just by looking at the blood, right? Can hair analysis, so it's mostly for the minerals, and then the heavy metals. Can it detect things like mold as well? No. No. Not, not for mold. Urine, urine analysis. That wouldn't go into your hair. That would be urine. Yes. But you can detect, uh, also radioactive, uh, radioactive elements such as uranium, thallium. Then the most common ones are mercury, lead, uh, cadmium, titanium. I can speak about them if you, if you want me to. Um, there's also gold, silver, which you may be in contact with through running water, since silver is used, is used for many things, and copper, which is an essential mineral, but when there's too much of it, it's toxic, sulfur, a trace element as well, strontium, boron. You can detect, uh, any, any metal, right? So, what happens if you start doing? Oh, okay. Before that question, what are some of the maybe junk material or toxins that our body internally produces? Because as far, if I, as I've understood it, it's not all that we need to get rid of the external pollutants and toxins, but there are a lot of things in our body that needs to be also that are created. They're like exhausted stem cells or things like that. Um, such as senescent cells. Yeah. Yeah. That tend that accumulates in every tissue and it affects the architecture and the physiology of the tissue and it makes you age faster. So, senescent cells are part of the normal functioning of the body, and they are essential for tissue healing and cancer prevention. So, in those animals that have impaired senescence building mechanisms, uh, cancer develops more easily because in a youthful state, they don't have a way to put a stop to cellular division. When the cell carries too many insults, such as double DNA, uh, strand, uh, ruptures, then that cell mutates and can become tumoral. So, then instead of that, the body has developed a mechanism to make it stop dividing, um, basically making use, making it useless. But in reality, what happens is that long-term, that cell keeps active, although it's not dividing, but keeps secreting junk. It keeps secreting inflammatory cytokines, and it keeps secreting pro-senescence factors that affect healthy cells, and then more and more cells become senescent, eventually degenerating the tissue and their, and the function of the tissue. M, so it, it is hypothesized that by reducing the burden of senescent cells of the body, we can extend the lifespan of every healthy cell, every tissue, and the lifespan of the stem cells that reside in every tissue. Let's say that by taking care of the environment, by not making it poisonous, which is what senescent cells do in the long term, once they have lost their initial purpose, um, we help those senescent cells that were asleep, that were like hibernating and were not aging, they kept, they were kept in a youthful state. We help them activate when they need it and produce more copies of the tissue cells that are needed to keep functioning. Mhm.
So, what is the risk of stacking longevity protocols if we don't do the detox?
The smallest risk you, you could have is not achieving any result. Okay? Because by loading the body with antioxidants, for instance, which would be done in the third step, in the regeneration step, or by loading it with NAD, we won't solve what's causing excess oxidative stress. We will just mask it, or maybe it won't even be enough. So, nothing that we do will compensate for the damage that's still going on. So, without repairing that damage, step three makes no sense. But in the worst-case scenario, step three could help in increasing the damage because we don't want to overactivate mutated cells. So, we risk theoretically increasing the risk of cancer if we repair damaged tissues. Okay.
Well, how do you then detox the body?
Okay. So, then phase two, as I told you, first, let's say the easy part would be to remove external toxins. It's, I'm saying easy, but it's not easy at all, but that would be the, the most, the simple approach. First, remove heavy metals, which can be done by oral and IV. So, once I know, once I have the exact profile of what the patient has accumulated, whether it's mercury, lead, or aluminum, depends also on the symptoms, of course, because, um, you never treat the, the test, you treat the symptoms, you treat the patient. So, if the patient clearly has brain fog, fatigue, memory loss, uh, impaired muscle coordination, which are mainly symptoms of mercury accumulation, and I see high levels of mercury in the test, in the mineral test, and I see high levels of aluminum, or high levels of, uh, cadmium, or other minerals as well, I will focus on mercury. Then, once we've removed these, uh, metals and these external toxins, the other ones would be, for instance, microplastics, which we know sauna, sweating, and physical exercise, aerobic physical exercise help in, in expelling from the body the microplastics. Uh, that can be done at the same time. Once we've removed as many microplastics and as many heavy metals as possible, then we start with the on the improvement of the internal toxins, the internal toxic factors that affect us and that make us age, uh, faster, such as senescent cells with senolytics, with senomorphics, which don't destroy senescent cells per se, but, uh, block them, and sometimes that's more desirable than using senolytics, which destroy them, because if you overdose senolytics, you increase inflammation in the short term, right?
And what are some of the supplements and protocols you use for this?
So, first, for heavy metals, for instance, lead, there's only one option, which is IV chelation. We use EDTA, uh, combined with, uh, lots of other ingredients, such as procaine, which is an anesthetic. Uh, we use high levels of, high doses of vitamin C, which also have a chelating effect, and that at those doses cannot be taken orally. I'm talking 5, 10, 20 grams of vitamin C. The oral threshold goes up to 2 grams, which is the highest concentration that's well tolerated. So, we go beyond that. And for mercury, you can use oral chelating agents, such as DMSA, that's the most validated one, but sometimes that's not enough, and you have to combine it with IV as well. Then, for the senescent cells, I really like curcumin because it's a safe and effective senomorphic that's been used for decades, and it, it also promotes apoptosis of damaged cells. So, it will remove junk that's accumulated in your tissues. And I really like quercetin as well, because it has a similar effect, but it also destroys, uh, senescent cells. Quercetin. Then, there's fisetin, which doesn't have evidence in humans yet, but it can be used orally and it's safe as a complement. I think the reason why it failed to provide evidence in animal studies so far in extending lifespan is because it's, uh, really poorly absorbed. It's a, it's a lipid-soluble flavonol. So, fisetin, in my opinion, is promising, but it needs, uh, more research. So, to sum up, fisetin orally as a complement, and intravenous curcumin, so turmeric extract, and quercetin. Okay.
What about things like, uh, many people would choose like activated charcoal or even clay once you have the toxins?
Well, my opinion is good, and they have, zeolithe, activated charcoal have a lot of evidence, but they're only useful while the toxins are still in your gut. So, for acute intoxications, once they have been absorbed, um, they're useless. All those, uh, absorbent agents, absorbent agents also absorb vitamins and minerals and nutrients. So, if you're taking them, make sure you don't take them together with your other supplements. Yeah, absolutely. Yeah, like overconsuming things like charcoal can actually then on the long term have a negative effect. Sometimes people think that more is better, but that's not the case. Yeah. So, we want to detox. I guess the take-home message here is that we want to detox the right stuff, and we want to preserve the nutrients that we want to like actually have our bodies absorbed. And for this, we need quite, uh, detailed and specific strategies for the detox that target that specific thing, like, for example, the mercury, that we need the specific things that point to that. That's great. That was a very good overview. Thank you.
Um, then the next step would be the regeneration, and with this, I thought we could go through of the skin and hair. You talked with Tim quite a lot about the regenerating the cells in general. And I know there is like, you came from the cosmetic world, world, and there is like quite a big, big request for this. And I would think that there is almost the, the general trend that I'm noticing is that skin is still thought to be sort of like, yeah, more like the aesthetic side, but still, skin is our largest, largest organ, and it protects us from pollutants. You told that it's a major absorption site for toxins and pollutants. So, it's a, it's a selective barrier. It allows you to absorb certain things, and it shouldn't absorb the bad things. But for instance, uh, one approach I'm, I'm kind of playing with now, or, um, trying at the moment, is, uh, topical transdermal peptides. Okay. Such as, such as NAD, for instance. Um, so, for patients that have tried intravenous NAD and oral NAD precursors, and they still haven't reached adequate levels, I'm now complementing those with liposomal formulations, which are basically like a serum that's applied into your most, uh, sensitive skin areas, where the skin is thinnest, like, behind your ear, or in the anterior aspect of your forearm. Arm, and then you allow for the, for the transdermal absorption of pure NAD that's been encapsulated. And, okay, have you already? Not yet. Not yet. I cannot, I cannot provide any insight, but it's promising. Same thing, what I, what I do have tried and has worked so far on myself is the delta wave peptide, which is a Russian peptide that's applied this way transdermally, and that improves delta sleep. So, the total amount of deep sleep, delta sleep is the deepest phase of sleep when you're most more unconscious. So, it should be at least one and a half hours. I've never had a trouble in reaching that, that threshold, but I wanted to see if it works. And, um, since my, my partner was in Russia, she's Russian, uh, one month ago, uh, she could bring me that peptide in particular, and I asked her to, uh, and she brought it. I tried it and see what happened, and I could reach for the first time two hours and fifteen minutes of deep sleep. Oh, okay. By complementing it, which is amazing. I felt amazing, uh, the day after. It's at the expense of light sleep, not of REM sleep. Okay. In my case. Interesting. Uh, was it your total amount of sleep was still the same? No. Total sleep same in total. So, about eight, eight and a half hours. But the, the deep sleep phase lasted longer, and then the short deep sleep phases that followed in between light sleep were more, more frequent. So, you give the body, uh, more time to repair and eliminate the toxins that accumulate, for instance, in your, in your brain. That's quite interesting.
Is this something that's currently applied in clinics regularly, or is it still more of an experimental research-based thing?
I, it's still only for research. Okay. But I think in general cases, it doesn't carry any risk. So, if it hasn't become mainstream, or if it's not seen often in clinical protocols, is because of, uh, um, it, it hasn't been widespread. It hasn't been, it's not a knowledge that has been widespread. We don't learn that in, in med school. We don't learn about peptides even in our master's degrees. So, it's something that the knowledge is out there, but you need to research for yourself. Right?
So, let's discuss, uh, the skin a little bit. What is, what are the other, are the principles of regenerating skin same as regenerating the body, or is there something, you know, special in the skin?
I would assume that all organs have their, their own protocols to some extent. Of course, yes. We, we cannot compare regenerating the brain, for example, or helping the brain make its function, which is an organ that basically has an extremely slow turnover of cells. There's barely any newborn neurons in the adult phase, um, with the skin, which is constantly regenerating, or it should be. A healthy skin removes all of its external layers every 30 days, whereas, uh, a heart takes, I think, about 18 years, and the brain lasts for our entire life and it barely regenerates. Um, so, in the case of the skin, I would say it's one of the easiest organs to regenerate. But the difference in the approach is that we have to cause some harm to activate its regenerative capacity. So, what do we use? Usually, we use peels, we use chemicals, we use lasers, we use things that damage the external layers of the skin, and as a response, those dormant stem cells that reside in the deepest layers of the epidermis receive, receive, uh, receive a stimulus, and they activate the cell turnover. They start dividing. They produce new, younger cells, and those replace the old ones, and that's, uh, to me, the best anti-wrinkle, uh, approach that we can have. But, uh, bear in mind that we need to cause some temporary damage first. So, you shouldn't overdo that. Yeah. Yeah.
For me personally, like, I, I suffered for years and years, this very deep acne scars in my face, and I tried all the creams and what not, like nothing helped until I started microneedling. Did you try by any chance, uh, tretinoin creams, retinoic acid, not retinol?
Um, tretinoin, I, I did try. It was very drying for my skin. So, too drying. I have, I had so sensitive, so fragile, so thin skin at that point that it was only, I started 0.25 needles as well, already together with, together with needles. No, no, no. That I tried. 0.25 microneedling. You were talking about the depth. I thought you were talking about the concentration of a cream. Ah, no, no, no. So, after that cream, I, I thought that, okay, I can't do this. So, I started the microneedling, and I'm like, whoa, what happens here? Like, my skin literally started changing. So, that goes to like, anecdotal evidence for the microdamage that is really essential for starting regeneration.
Definitely. That's, that's a good way to, to regenerate the skin, and I use it usually at, at the clinic for, for acne scars, for striae as well, and for superficial wrinkles. But for deep ones, you need to use, uh, things that reach the dermis. So, not even with the, with the deepest, uh, depth, with the, with the, with the strongest microneedling, you could reach the deep layers of the dermis. M, so, in those cases, it's preferable to use, uh, the so-called, uh, ablative fractional lasers, such as CO2 laser, which basically creates a column of, uh, microscopic column of, uh, temperature that reaches the bottom of your skin and burns it without burning the surrounding tissues, therefore allowing for the surrounding stem cells to activate and repair. And that same thing can be applied for acne scars. So, for instance, if you want to use the lesser invasive approach, you can do 10 sessions of microneedling. But if you want quick, instant results, you can do one to two sessions of, uh, CO2 laser, and you will achieve it in, in one quarter of the time, but you will have your face burnt for a few days, and you'll have to take a lot of care.
Yeah, I actually did that once. I did the CO2 laser. It was quite, it was quite a hard treatment. I had a downtime of altogether four months. I wasn't able to travel to sunny places and had to protect my skin a lot, and, um, I, I guess that was effective, but I still prefer the derma rolling because it's something that's a bit more gentle, but yeah, of course, with the deep, deeper scars, it was maybe a bit more effective then.
What, what do you think are the biggest things that are damaging our skin? Like photoaging is one. What other things we need to do to protect our skin from aging and getting wrinkled up?
Definitely. Well, first, as I told you, in 2021, I changed my focus. I stopped working only on the external signs of aging. And I would, my answer back then, my answer before 2021 would have just been probably, uh, avoid, like creams that contain alcohol, avoid, uh, avoid silly, uh, creams with, uh, with silly ingredients. Um, try to stick to the basics. To use a natural sunscreen as natural as possible, as without endocrine disruptors, and use an SPF 50 plus during the whole year, not just in summer months. Second, use a retinoic acid or another retinoid cream if your skin is too sensitive to retinoic acid, which is the, the most potent one, the strongest one. It's my favorite tool. So, if I had treated you a few years ago when you had the acne scars, not now that you have the, uh, amazing supple skin, Inca, thank you. I would, I would have probably given you microconcentrations of tretinoin instead of starting directly with the microneedling. I would have started with the cream, but at really small concentrations, which can only be given by compounding the creams. So, you don't have commercial concentrations at 0.015. The, the lowest one starts at 0.25, which for some people is too much. Then, after a few months, I would have given you the microneedling, and, uh, parallel to that, my new focus is in improving diet, gut health, and of course, treating biological aging. So, I would have given you the senolytics, I would have removed your toxins, the whole package at the same time, not just treating the, the appearance or treating the skin itself. It's a more holistic approach, but in the long term, it's what provides the best results.
Yeah. Let's discuss some of the supplements and the internal things that we need to do to protect our skin as well.
Of course. Collagen supplements are one of the most known ones, especially like collagen peptides, which I currently use, and I've seen like major improvements compared to when I was using the, the like collagen peptides. So, way more potent. Um, what other things we need to do internally to make sure that our skin gets nourished and supple and anti-aging or regenerating?
Let's start by understanding what happens to skin as we age and what skin loses. It mostly loses in the extracellular matrix its content in water due to loss of proteoglycans, because the collagen fibers become entangled, broken, and they don't carry as much, uh, elasticity. They don't, lose the, this elastic property they, they should have, and we lose the hyaluronic acid from the extracellular matrix that contains the water. So, collagen provides the elasticity. So, the ability for skin to get back to its previous position, um, with, uh, mimicking or with tension, any sort of mechanical tension. And hyaluronic acid provides it with hydration, suppleness, and, uh, it also allows for intercellular communication. So, without water, without fluid, cells don't receive messages. They do, they wouldn't receive them optimally. Therefore, we need to improve. We need to provide hyaluronic acid orally or intradermally, not topically. Topically, unless it's encapsulated, which is something that's still undergoing research. I don't really believe any hyaluronic acid serum works at the moment. It basically acts as a lubricant. So, it makes you feel good. It makes you feel hydrated. But once you wash your face, you get back to your previous stage. And therefore, you need to inject it directly into the dermis. That's done using the, what's called mesotherapy technique, which is tiny needles that perforate the skin. You make lots of tiny pinches all throughout your, your face, your neck, all the area you need to improve. And, uh, that creates like tiny papules, tiny pimples, uh, for a few hours until the hyaluronic acid and the other vitamins and minerals that we inject dissipate in what's called the third circulation, which is the dermis. So, it dissipates, it extends, and it reaches the whole area. Um, orally, hyaluronic acid has proven beneficial for both hydration and, uh, the aspect of wrinkles of the skin in several meta-analyses. Um, it's the effective doses start at 150 milligrams, and it can be absorbed well. But bear in mind that it's not the same treating you than treating a 70-year-old. A 70-year-old is going to need a lot more hyaluronic acid, and the body will not prioritize the skin. So, it will send the X amount that you give them first to the cartilage, and last to skin and hair. Therefore, I would give him probably 500, 600 mg, not 150, daily. M.
Then, apart from collagen, which has been extensively spoken about, and I think it's not worth, it's not worth speaking about it, uh, today, we have astaxanthin and beta-carotene. And all carotenoids for that matter can help skin. They act as an internal sunscreen, increasing melanocyte activity, so producing more melanin, and also reducing the oxidative damage that accumulates in the skin, either by aging itself or by photoaging caused by, by sun radiation. So, I think they are a, a must-have in your, in your skin supplement protocol. And my favorite is astaxanthin. Um, although it depends on the case. In other cases, it may make sense to supplement lutein and beta-carotene, but that converts into vitamin A, which accumulates and can become toxic, whereas astaxanthin does not. So, and astaxanthin has more evidence in, um, human studies regarding skin, and I, I like it. I like it, uh, also for its, uh, effects on, uh, antioxidant, uh, capacity, on improving the antioxidant capacity in the rest of the body. And, uh, I think it was the ITP study also showed that in animals, it extends lifespan by around 20% in mice. So, I really like that for that. I really like it for that reason, too.
That's great. What do you do for your own skin?
What do I do? Well, same thing I apply to, to my patients. Uh, so, basically, I use a tretinoin night cream with other ingredients. It has, at the moment, I keep changing it depending on, on my appearance and depending on the time of the year, but at the moment, my current formula also contains melatonin. It contains DMAE, which is dimethylaminoethanol. It's an antioxidant, and it also provides elasticity and improves, uh, improves, uh, the wrinkles. It's, uh, it's, as I told you, it's, it's a firming agent. It, it creates, uh, more tension in the skin. It has 0.12 at the moment, tretinoin, 0.12. I've been increasing it by 0.02%, 0.02% every six months for the past six years, and I tolerate it well, and I don't use it alternately. I use it every day. Uh, what else? Uh, that's at night. It has more ingredients. I forgot about them now. Uh, but, but it's a really complex formula, um, which, by the way, I give to all my patients in, uh, the different protocols that I apply. They all include a skin analysis and hair analysis with a personalized formula for skin and hair. Then, during daytime, currently I'm using the, the French, uh, sunscreen brand SVR, which is a chemical sunscreen, but it does not contain endocrine disruptors. I find it more comfortable than mineral sunscreens. But when I go to the beach or I spend long time, a long time outside outdoors, I use, uh, Badger, the Badger brand, which is a natural brand from the United States that only contains non-nano zinc oxide. And it's pretty heavy, chalky, chalky sunscreen, but it's, uh, super safe for both you and for the ocean. So, I use it outdoors. I crossed the Sahara desert with that sunscreen and I came back as pale as I am now. So, Oh, wow. Okay. Yeah. Those pretty effects there. They make the white cast to the face. But I know like surfers use that. That's Badger is for surfers actually. Yes. Yes. But it's, it's too heavy to wear it on, on a day-to-day basis. So, I use SVR, the SPF 50 plus crème mousse. That's my favorite because it's really silky to the touch. It doesn't give you the sensation of wearing a cream. It, it basically, you don't feel anything in your face. So, that's, I think most men would like that. Yeah. Yeah. I also know one other one, which is the La Roche-Posay. Yeah, I, I use that one. I love it. I stopped, I, I stopped recommending it because I got pretty strong sunburns with it, and I have a few patients with melasma, which have had relapses by using it. But those are very specific cases, and I don't know of anyone else that has had burns using it. So, that's, it's not a bad sunscreen. Yeah, it's one of those sunscreens that I run all the time as recommended ones in this longevity space. So, that's quite interesting. But maybe I'll try yours as well. But it totally protects about you, uh, from, from UV radiation. The Anthelios, Anthelios XL Ultra Fluid, I think that's its name. That one lacks protection against infrared light and against, uh, visible light. So, it's a matter of concern for people prone to sunspots and melasma. So, I tend to recommend things that contain the whole, the broad spectrum filters, and SVR has them. By the way, I don't have any affiliations, any affiliations or anything with any of these brands. I just recommend what I've tried on myself and my patients and, and I've eventually liked. But, uh, there's many other brands. There's many other good brands. For instance, Avène, which is also French, has the acne-prone skin supplement, uh, skin sunscreen, which is also natural and it does not, uh, contain endocrine disruptors, and it has the, the broad spectrum. Great.
So, back to my routine, uh, apart from what I told you, I have, uh, at the moment, I'm having injections every three months in my hair of, uh, exosomes and PRP, and in my face, I'm injecting vitamins, minerals, and hyaluronic acid, and I'm willing to try exosomes in my face too, but I'll combine, I won't replace what I'm doing at, at the moment, and probably I'll do like one session a year of exosomes to improve difficult areas such as the eyelids, which are the ones that usually show more premature signs of aging, right?
And have you noticed with this routine that you're doing, have you noticed a clear reduction of signs of aging? I mean, you're still pretty young, so maybe you cannot see them that well.
Not so much, not so much, but yes, I can't complain, really. I have noticed, I have noticed. I could tell you when I started almost 10 years ago, my wrinkles in the eyelid area were deeper, and I haven't evolved any deep expression wrinkles, although I tend to use my forehead a lot when I read and when I study. I tend to do the, the frowning gesture to, uh, concentrate better, a lot, and that's also an improvement. Not worsening is also an improvement, since I'm almost 10 years older, and I haven't used Botox on myself. Although I'm all for it. If in the future I need it, I'm going to use it. Yeah.
Uh, what is your view on the toxicity of Botox? So, I feel like there is sort of like a hate-love relationship with Botox going on in the space, which is like, you know, it's true, you either hate it or love it. It's, yeah, it's like, uh, some people say that it's absolutely toxic and that will accumulate and, you know, that's not good. Whereas the meta-analyses that I found, actually haven't found that much like harmful effects, long-term effects of, of botulinum toxin. But there's no study so far showing any proof of accumulation in the body and any signs of short or long-term toxicity when used in therapeutic doses. So, first thing, we must clarify is that it is indeed a toxin. It's actually the most powerful toxin known on planet Earth. But we must understand how it works and why it could be toxic in high doses. So, botulinum toxin is produced by Clostridium botulinum, which is a strain of bacteria that, uh, loves, uh, canned food. So, when, when you eat a contaminated can of, uh, meat, for instance, uh, that's, that's expired long ago, uh, you may be eating around 2,500 to 3,000 units of Botox, and that is going to cause paralysis of your respiratory center in your, in your, uh, central nervous system, and therefore, you may die because you're not, you're unable to breathe. But it's not toxic at a cellular level. It basically interrupts neurotransmission of the acetylcholine, uh, synapsis. So, without acetylcholine, smooth muscle can't contract, and you stop breathing, and you stop bowel movement, and that's basically it. So, once we understand that, once we understand that there's no accumulation as it, of toxins inside cells, as it would happen with mercury, for example, which accumulates inside your nerves and creates, uh, neuronal inflammation, and in the long term, it, it can, it can contribute in developing Alzheimer's or other types of dementia. H, in this case, botulinum toxin stays in the synapses between neurons for some time until the body clears it out, which is between four to six months. And I, I guess that this point is, uh, relevant to inform any listener that now we are not talking about the neurotransmitter in your brain. So, as it, the Botox doesn't travel to your brain and prevent your neuroplasticity and memory formation. So, we are talking about the neuromuscular connection that is local for where it's injected. We use it where, where, where we need it. So, we inject it in the forehead muscle, it will stay there. It will block the neurotransmission only there. It won't affect any other nerve. So, for instance, it's been used in, in children with, uh, paralysis in much higher doses than it's used in aesthetics, and without any reports of adverse effects other than weakness of the limb that's been injected, obviously, which may happen, but it depends on the dose. So, I would say 30 to 50, 60, sometimes 100 units of Botox is perfectly normal for an aesthetic treatment. Up to 500 units is perfectly safe and it's proven safe for migraine treatments, for muscle spasms, for paralysis, for urinary incontinence. There's, the list goes on and on. There's growing indications every day for Botox. Uh, even, uh, for seborrheic dermatitis, for your scalp, when, when you secrete too much oil, it basically blocks the smooth muscle inside your, your oil glands from your scalp, and it provides relief of the, of the scaling and all of the itchy, itchy symptoms that it produces.
So, thanks so much for, for this view because I really wanted to learn it or hear it from you and your opinion on your insight, just because I know how much you appreciate the natural way and your whole approach is about don't get toxins in your body and, and, and you care about the cellular regeneration that, uh, yeah, what's the, what's the food sort of mind this stuff?
Definitely, definitely. And if I can avoid using Botox, I'll be the first one to, to do it. But, uh, we must also understand that as we age, our facial mimics, the exposure to repeated muscular tensions over time develops into wrinkles that cannot be treated by any other methods. So, if, if aging has made our forehead muscles too strong, we need to address that with the right tool. And in this case, it would be Botox. And for instance, if we have developed a muscle contracture in our back, which gives us a lot of pain every day because of our posture, because of our bad posture, or because of, uh, an anomaly in our skeletal, uh, system. For instance, scoliosis can develop, uh, muscle contractures. Uh, then we need to treat that excess strength that's causing the pain or that's causing that, uh, malformation in your back, and that's the tool in, in, in that case, has an indication as well.
Yeah, I, I've seen insane results with microneedling as well, and dermarolling seems to also be because it thickens the skin, right? So, dermarolling, it can give the impression of thinning the skin at first, but it really thickens it.
Yeah. Our skin atrophies, so it becomes, the active layers of the skin be, of the skin become thinner, and what becomes thicker is the dead layers. We accumulate lots of dead cells on top of the epidermis. That's called the stratum corneum layer. Then, what microneedling or any, any other mechanism by which we create an abrasion and a damage, a controlled damage on the skin, for, for example, tretinoin or chemical peels or lasers, is going to remove all that dead skin and create new cells. So, what there is available for hair? So, alopecia is kind of, uh, very difficult to treat problem, and how can, so how can, what causes, let's say, what causes, let's say, uh, balding like male pattern balding, female pattern hair loss, and thinning during aging? And is there something that we can do to prevent and treat it?
Sure. There's so many causes that we could do an entire podcast about it, but let's speak about the most frequent ones and the ones that affect us the most during aging. So, in normal conditions, the most common causes of hair loss, both male and female, are androgenic alopecia, which is male and female pattern hair loss, mostly contributed by, uh, sexual hormones, either low estrogen or high testosterone, but mostly high testosterone, and more specifically, high dihydrotestosterone, which is the active form. H, and the other one is telogen effluvium, which is basically, it should, it's normal as long as it doesn't last for more than three to four months. But there's lots of factors that contribute in making it chronic. And it tends to affect more women because it also depends on the levels of, of iron. And women tend to be lower in, in iron, tend to be to suffer more from anemia. That's natural. But that's something.
We must pay attention to, uh, when diagnosing, uh, hair loss because, uh, if there's any nutrient deficiencies, we have to address them. As, again, as I told you with skin, the, the body doesn't care that much about hair and skin. If it has a heavy deficiency in one mineral, uh, that it needs to provide function for the, the vital organs, it's going to direct everything to the vital organs and forget about the hair.
So, um, main causes, we've said hormones, sexual hormones. We've said nutrient deficiencies, but also medications. There's hundreds, if not thousands of medications that cause hair loss. For instance, I'll give you an example that you'll be familiar with. Sertraline. Sertraline is one of the most prescribed anti-anti-depressant drugs, uh, causes hair loss and it can be chronic. Uh, what else? Antihistamines can cause hair loss. Virtually, antihistamines, some, some of the first-generation antihistamines that some people take for, for sleep and for pruritus, so itchiness. Anyway, medications, we must check what the patient is taking. Also, heavy metals accumulated in the body, accumulated in the hair. Other toxins that we don't know.
Um, aging itself, that's called, that's called senile hair loss, senile alopecia. That's the, I would say, most difficult to treat. But by regenerating the hair follicle, providing it with exosomes, providing it with growth factors, we can again switch on the dormant stem cells that remain there. If we take care of those, we can extend the, the lifespan of the hair and the, and its quality. So make it thicker. And with hormones. Yes.
Yeah. How does the exosome treatment for the hair look like? How does it look like? It's injection. The same, same way I would inject, uh, I would inject vitamins in, in your skin. I could inject exosomes in your hair. They come in lyophilized vials. So it's, it's very simple. It's very easy for the patient. There's PRP as well. I like both. PRP works better in younger people and it's more affordable than exosomes. So in your case, in my case, as I told you, I'm using PRP. Although I'm also using exosomes because I have easy access to them. Um, I can buy them directly to the, to the lab for, uh, so I, I cut the, the doctor's, the doctor's cost if I inject myself. So I, I combine both and they provide different profiles of growth factors. But for a young person that is otherwise healthy, I would say PRP works very well, especially for telogen effluvium in women. In men, if we want to treat the androgenic alopecia, we must address hormones in any case. In women, we don't need to because there's not such a clear relationship in every case. So, it's more of a trial and error approach. If we try PRP and it doesn't work, then we may try with some hormone blockers or we may try with some, uh, estrogen drops that you apply in your hair together with minoxidil, which increases blood flow.
So a basic protocol for, uh, male pattern hair loss would look like this. First thing, stimulate blood flow with topical solution of minoxidil and then block DHT either topically, which doesn't have any side effects with the same drops. You can apply the, the drugs that block it such as finasteride or dutasteride and it has some effect. It's not super effective in every case, but it may help when you're very young and you still have a lot of hair. Then the second line of treatment would be injecting, not exosomes, not PRP at first, but these DHT blockers combined with vitamins and minerals directly into your hair follicle to help it grow. And on top of that, you can add PRP, but that's complimentary for men. And then the third line of treatment, that's the one that's, that's proven most effective, but also with the most adverse effects, is the oral treatment with both minoxidil to increase blood flow orally and dutasteride, finasteride to block DHT, but that has unintended consequences. I try to avoid that as much as possible, but sometimes there's no other way and it always will depend on how important, how, how much importance the, the patient gives to, to his hair loss problem, right?
What's your opinion or, or, um, like experience on some of the NRF2 activators that also were popular at least at one point, like curcumin, sulforaphane, resveratrol? They're effective. Probably any NRF2 activator will help because the way DHT damages the follicle in androgenic alopecia is by increasing the amount of reactive oxygen species. So any antioxidant for that matter, either through the NRF2 pathway or through direct antioxidant effect, is going to work. Uh, but I don't use them with that purpose. I have, I don't have experience using those. I would say I usually use, uh, in my, in my topical formulas, antioxidants such as ginseng. I use, uh, like Ginkgo biloba as well. Those have some evidence. But we can use more complex ones such as melatonin, which I love. You may know that already. I use it in my, in my face. So why not in my hair as well? Yes, I apply daily, nightly minoxidil drops that contain melatonin because it's proven to extend the anagen, the growth phase of the hair by protecting the cells from reactive oxygen species. And with melatonin, and like with other antioxidants, you don't run the risk of overdoing antioxidant. It's not like vitamin C or like, uh, astaxanthin. So it acts more indirectly, increasing it, it goes, it works through the NRF2 pathway actually, same as sulforaphane. So it's an indirect pathway and let's say that there's a funnel to its effect. If you give a lot of it, it's not going to provide too much antioxidant effect. Okay.
So when it comes to hair, it's like it should be, as well as with, with the skin, would you say that the most effective approach is to combine the internal regeneration and the topical and focal treatment? Mhm. Yes. Uh, in terms of supplements for hair, I would that would be secondary. So I would pay attention to diet. I would make sure the patient has, doesn't have any leaky gut issues and he absorbs well any nutrient. Um, and I, I'll make sure he or she eats well and eats plenty of whole foods. And if that's fulfilled, there's no need. Empirically, there's, it's, it's usually done, but there's no need. It's, there's no proof that giving extra vitamins and extra minerals in supplement is going to help your hair grow more or fall less. So that's secondary and it's, you, I use it on a trial and error approach. So I will focus on a good diagnosis and see if it's a telogen effluvium, uh, increase growth by any means, PRP, minoxidil topically, orally, inject it. I can inject, uh, vitamins and minerals, but that's also secondary. I will, I will focus on injecting, uh, for instance, melatonin if I suspect, if the patient has an autoimmune disease that may be contributing to, uh, more hair loss, then I will inject melatonin in, in their hair to reduce local inflammation. And then if it's a male or female pattern hair loss, I will try to bring the, the DHT levels down to a more stable level that does not cause hair loss, but that does not develop any adverse effects such as loss of libido, such as, um, loss of physical performance or fatigue or any of the other, uh, side effects, which I would say, the worst one is, develop, development of mammary gland in males. It's very rare, but it's been reported and no one wants that. So, um, I'm the first one to avoid it as much as possible and to use it with caution. Right.
Thanks so much, Alex. This has been such a great overview on all of the skin regeneration, hair regeneration. Uh, now if someone is like, okay, I'm so inspired to start treating my skin, hair, and longevity and regenerating myself. What would be like one of the advice that you would say, like, okay, start with this today? Mhm. Start paying attention to your diet. Start paying attention to your habits, mostly your sleep, your levels of activity. Try to focus on that and optimize that before entering more sophisticated strategies and before supplements and before any medical treatments. And once you take, once you, once you have the healthiest lifestyle possible you can have on your own, then seek help to go the extra step, to take the extra step, or go to the next level. Yeah. And detox the body. Detox the body. Yes. Drink a lot of water. Definitely practice sauna if you have any available nearby. Uh, practice lots of physical exercise. Doesn't matter which type, as long as you keep moving your body and sweating. Uh, sleep well, focus on sleep. I would say organize your day accordingly. So, so to guarantee a really good night's sleep, restful, high quality, and long good night sleep. And what else? And then be careful, be mindful of sun if you want to keep a youthful appearance in old age. And take, take care, take use sunscreen every day. And that doesn't mean you cannot spend time outdoors. Of course, you must spend time outdoors and receiving sunlight is healthy, but, uh, protect your skin and maybe in that sense, you can already start supplementing with astaxanthin and other carotenoids as a compliment to your, to your sunscreen. Great.
And, um, please provide the links and your web page to your clinic and to your Instagram and social media. Sure. Well, um, I'm on Instagram. My Instagram is Alexis Ortega with a lower hyphen MD with another lower hyphen. And there you can, you can follow me and I publish, uh, a lot on longevity strategies, uh, on what I do at my clinic, on my protocols, both for aesthetics and for, um, prevention, preventive medicine. And you also have my, my clinic's website is www.astracl.clinic.com. Thank you. Where you can. Yeah. Go, go, go, go, go. Instagram. It's like, it's such a good information. You have very nice infographic posts about different aspects of longevity. So I feel like I'm following you. I learn something new every day. So thank you. That's a great compliment. Thank you so much.